PDF(Pubmed)
Abstract：
Treatment of critically ill patients with venovenous (V-V) extracorporeal membrane oxygenation (ECMO) has gained wide acceptance in the last few decades. However, the use of V-V ECMO in septic shock remains controversial. The effect of ECMO-induced inflammation on the microcirculation of the intestine, liver, and critically damaged lungs is unknown. Therefore, the aim of this study was to measure the hepatic and intestinal microcirculation and pulmonary inflammatory response in a model of V-V ECMO and septic shock in the rat. Twenty male Lewis rats were randomly assigned to receive V-V ECMO therapy or a sham procedure. Hemodynamic data were measured by a pressure-volume catheter in the left ventricle and a catheter in the lateral tail artery. Septic shock was induced by the intravenous infusion of lipopolysaccharide (1 mg/kg). During V-V ECMO therapy, rats received lung-protective ventilation. The hepatic and intestinal microcirculation was assessed by micro-lightguide spectrophotometry after median laparotomy for 2 h. Systemic and pulmonary inflammation was measured by enzyme-linked immunosorbent assays of plasma and bronchoalveolar lavage (BAL), respectively, which included tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), IL-10, C-X-C motif ligand 2 (CXCL2), and CXCL5. Reduced oxygen saturation and relative hemoglobin concentration were measured in the hepatic and intestinal microcirculation during treatment with V-V ECMO. These animals also showed increased systolic, mean, and diastolic blood pressures. While no differences in left ventricular ejection fraction were observed, animals in the V-V ECMO group presented an increased heart rate, stroke volume, and cardiac output. Blood gas analysis showed dilutional anemia during V-V ECMO, whereas plasma analysis revealed a decreased concentration of IL-10 during V-V ECMO therapy, and BAL measurements showed increased concentrations of TNF-α, CXCL2, and CXCL5. Rats treated with V-V ECMO showed impaired microcirculation of the intestine and liver during septic shock despite increased blood pressure and cardiac output. Despite lung-protective ventilation, increased pulmonary inflammation was recognized during V-V ECMO therapy in septic shock.
摘要：
在过去的几十年中，静脉静脉（V-V）体外膜氧合（ECMO）治疗危重患者已获得广泛接受。然而,在感染性休克中使用V-VECMO仍存在争议.ECMO诱导的炎症对肠道微循环的影响，肝脏,严重受损的肺部未知。因此,这项研究的目的是测量大鼠V-VECMO和感染性休克模型中的肝脏和肠道微循环以及肺部炎症反应。20只雄性Lewis大鼠被随机分配接受V-VECMO治疗或假手术。通过左心室中的压力容积导管和尾外侧动脉中的导管测量血液动力学数据。通过静脉输注脂多糖（1mg/kg）引起感染性休克。在V-VECMO治疗期间，大鼠接受肺保护性通气。中位剖腹手术2小时后，通过微光导分光光度法评估肝脏和肠道微循环。通过血浆和支气管肺泡灌洗（BAL）的酶联免疫吸附测定来测量全身和肺部炎症，分别,其中包括肿瘤坏死因子α（TNF-α），白细胞介素6（IL-6），IL-10，C-X-C基序配体2（CXCL2），和CXCL5。在用V-VECMO治疗期间，测量了肝和肠微循环中降低的氧饱和度和相对血红蛋白浓度。这些动物还表现出收缩压增加，意思是，和舒张压。虽然没有观察到左心室射血分数的差异，V-VECMO组的动物心率增加，每搏输出量,和心输出量.血气分析显示在V-VECMO期间稀释性贫血，而血浆分析显示，在V-VECMO治疗期间IL-10的浓度降低，BAL测量显示TNF-α浓度增加，CXCL2和CXCL5。尽管血压和心输出量增加，但在感染性休克期间，用V-VECMO治疗的大鼠显示肠和肝脏的微循环受损。尽管有肺保护性通气,在感染性休克的V-VECMO治疗期间,肺部炎症增加.
